Office of Student Financial Services
Federal Direct Parent Loan
William D. Ford Federal Direct Loan Program
Consent to Obtain Credit Report
The student of a parent that has an adverse credit history may be eligible to borrow additional funds from the Direct
Student Loan program.
Student’s Name ____________________________________________ Student Date of Birth _________________
Student’s Social Security Number ______________________________ Student ID #_________________________
Parent Information (REQUIRED):
Please print clearly
Parent’s Name ___________________________________________ Social Security Number _____________________
First
M.I.
Last
Birth Date (month/day/year) _______/_______/_______
Phone Number _____________________________________
Are you a US Citizen? Yes _______ No _______
Email Address _____________________________________
Permanent Address:__________________________________________________________________________________
Street
City, State, ZIP
Driver’s License # ________________________________________________ State _____________
I consent to the U.S. Department of Education and its agents obtaining a report of my credit record and using the
information from that report in determining whether to make a Direct PLUS Loan to me. I understand that I will be
notified of the results of the credit check.
Parent Signature ___________________________________________
Date ______________________
Privacy Act Disclosure Notice
The Privacy Act of 1974 (5 U.S.C.552a) requires that the following notice be provided to you. The authority for collecting the information requested
on this form is §451 et seq. of the Higher Education Act of 1965, as amended. Your disclosure of this information is voluntary. However, if you do
not provide this information, you cannot be considered for a Direct PLUS Loan. The information on this form will be used to determine your
eligibility for a Direct PLUS Loan. The information in your file may be disclosed to third parties as authorized under routine uses in the Privacy Act
notices called "Title IV Program Files" (originally published on April 12, 1994, Federal Register, Vol. 59 p. 17351) and "National Student Loan Data
System" (originally published on December 20, 1994, Federal Register, Vol. 59 p. 65532). Thus, this information may be disclosed to federal and
state agencies, private parties such as relatives, present and former employers and creditors, and contractors of the Department of Education for
purposes of administration of the student financial assistance program, for enforcement purposes, for litigation where such disclosure is compatible
with the purposes for which the records were collected, for use by federal, state, local, or foreign agencies in connection with employment matters or
the issuance of a license, grant, or other benefit, for use in any employee grievance or discipline proceeding in which the Federal Government is a
party, for use in connection with audits or other investigations, for research purposes, for purposes of determining whether particular records are
required to be disclosed under the Freedom of Information Act, and to a Member of Congress in response to an inquiry from the congressional office
made at your written request.
Because we request your social security number (SSN), we must inform you that we collect your SSN on a voluntary basis, but section 484(a)(4) of
the HEA (20 U.S.C. 1091(a)(4)) provides that, in order to receive any grant, loan, or work assistance under Title IV of the HEA, a student must
provide his or her SSN. Your SSN is used to verify your identity, and as an account number (identifier) throughout the life of your loan(s) so that
data may be recorded accurately.
Return completed form to:
Student Financial Services, P.O. Box 971, Rensselaer, IN 47978
FAX: 219-866-6144
E-mail: financialaid@saintjoe.edu